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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602907
Report Date: 04/15/2024
Date Signed: 04/15/2024 11:56:34 AM

Document Has Been Signed on 04/15/2024 11:56 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME:SAPPHIRE ADULT RESIDENTIAL HOMEFACILITY NUMBER:
198602907
ADMINISTRATOR/
DIRECTOR:		EZIWHOU, CHIMENEMFACILITY TYPE:
735
ADDRESS:1306 S CENTRAL AVENUETELEPHONE:
(415) 374-0060
CITY:COMPTONSTATE: CAZIP CODE:
90220
CAPACITY: 5CENSUS: 4DATE:
04/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Roseline Osuji, CaregiverTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 04/15/2024 at 8:40 am, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced annual required visit using the Care Inspection Tool. LPA met with Caregiver, Roseline Osuji, and explained the purpose of today’s visit. The facility is licensed to serve 5 clients ages 18 to 59 years old, 5 ambulatory clients, of which one non-ambulatory.

There are currently four (4) clients in placement. The facility consists of living and dining rooms, office, kitchen, washer & dryer located off the kitchen, 4 bedrooms, 2.5 bathrooms, front and back yards.



LPA Shirley and Abii toured the physical plant. There are no bodies of water or firearms on the premises. All client rooms were checked. Beds and bedding were in good condition, adequate lighting provided, storage for client personal belongings was observed. Walls and floors were in good repair. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 115.5 F. All fire extinguishers were operable.

A comfortable temperature is maintained in the facility. LPA observed the facility to be clean and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning agents, toxins, and sharps were inaccessible to clients. The kitchen was inspected and there is enough perishable and non-perishable food available which is stored properly. Fire extinguishers were charged, smoke detectors and carbon Monoxide were operable. LPA checked first aid kit; and found that it was compliant with a manual.

LPA also observed that the facility has a 30-day plus supply of Personal Protective Equipment (PPE). And all mandated posters were posted.

There were no deficiencies observed during today’s visit. Exit interview held and a copy of the report was provided to Obichukwu Abii.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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